GI - Intussusecption

Question 1

define intussusecption

Answer 1

the prolapse of one part of intestine into the lumen of the adjoining distal part.

Question 2

what age does intussusecption usualy affect

Answer 2

3 months - 2 years
m > f

Question 3

pathophysiology of intussusception

Answer 3

The telescoping of one bowel segment into another can lead to intestinal obstruction

can occur anywhere in bowel

Question 4

mc movement that occurs in intussusception

Answer 4

of the ileo-colic type
whereby the distal ileum passes into the caecum through ileo-caeceal valve

Question 5

pathological causes of intussusecption

Answer 5

mainly idiopathic but:
- Meckel diverticulum (most common)
- Polyps
- viral illness
- Henoch-Schönlein purpura
- Lymphoma and other tumors
- Post-operative

Question 6

sx of intussusecpetion

Answer 6

acute onset of:

• Severe, colicky abdominal pain
• Bilious (green) vomiting
• Redcurrant jelly stool (a mix of blood, mucus and stool) is a later sign

Question 7

how does child with intussusecption appear between episodes

Answer 7

parents will normally report the child returns to their normal self.

Question 8

what to loook for in examination for intussuecption

Answer 8

Distention
“sausage-shaped” mass in the right upper quadrant.
Signs of peritonism
Presence of bowel sounds
signs of dehydration or shock

Question 9

ddx for intussusecption

Answer 9

• colic
• testicular torsion
• appendicitis
• gastroenteritis
• volvus

Question 10

how to confirm diagnosis of intussecption

Answer 10

imaging:

1. abdominal x ray
2. abdominal ultrasound - GS
3. contrast enema

Question 11

why is abdominal x ray not reccomdned in intussusception

Answer 11

may confirm the diagnosis, however is not recommended due to low sensitivity

Question 12

what does abdominal x ray show in intussusecption

Answer 12

Distended small bowel loops

A curvilinear outline of the intussuception

Absence of bowel gas in colon distal to intussuception site

If perforation has occurred Rigler’s sign may be present

Question 13

what does abdominal ultrasound show for intussuspection

Answer 13

Doughnut/target sign on a transverse plane

Pseudokidney sign on a longitudinal plane

Question 14

why is ultrasound preferred method of diagnosis for intussecption

Answer 14

high sensitivity in comparison and can exclude alternative diagnoses

Question 15

how does contrast enema diagnose intussuecption

Answer 15

contrast media fails to adequately pass through the obstruction.

n some cases it may also be therapeutic as the introduction of contrast media into the bowel may reverse the bowel invagination.

Question 16

when is contrast enema contraindicated

Answer 16

if there is evidence of peritonitis or perforation.

Question 17

how to manage intusspeciton

Answer 17

1. fluids
2. NG tube
3. non operative reduction
4. surgical reduction

Question 18

what is non operative reduction when treating intussuspection

Answer 18

involves the use of an air or contrast enema to reduce the intussuscepted bowel.

Question 19

why are liquid enemas worse for nonoperative reduction when treating intussuspection

Answer 19

considered less safe, take longer to perform and the outcomes are technique dependent

Question 20

when is surgery used for intussusecption

Answer 20

Should a child have any contraindications to enema use or enema intervention is unsuccessfulc

Question 21

complications of intussusecption

Answer 21

obstruction
perforation
dehydration & shock